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Thursday, June 20, 2019

Official Changes to the Ratings of Infectious Diseases, Immune Disorders, and Nutritional Deficiencies

The following changes will go into effect
August 11th, 2019, and we’ll officially update all the information on our
website at that time. These new ratings will automatically apply to any new
claims for Infectious Diseases, Immune Disorders, and Nutritional Deficiencies submitted
on or after August 11th.

The following are the VA’s final changes to
the ratings for Infectious Diseases, Immune Disorders, and Nutritional
Deficiencies. The changes are fairly extensive, so I’ll walk through each, one
at a time.

For each condition, the ones labeled -Current- are the codes as they are right now. Click on the links to be taken to
the discussion of that code on our site. After the current code, I’ll discuss
the final changes and then VA’s justification.

__________________________________________________________________

-NEW-
General Rating System for Infectious Diseases

A 100% rating is
given for all active diseases. Once the infection is eliminated or completely suppressed,
the condition must be re-evaluated and rated 0%. Any lasting side effects
caused by the infection are then rated separately.

The VA is creating a General Rating System
for Infectious Diseases. This doesn’t have a huge effect on the ratings as
currently all infectious diseases are rated 100% while active, then on residual
symptoms/conditions. Regardless, creating a central rating system like this
will more greatly ensure consistency in applying the ratings to infectious
diseases.

The addition of a 0% rating for an inactive
disease also doesn’t have any direct impact on the ratings themselves, but will
allow for an easier adjustment to the ratings if the disease relapses.

__________________________________________________________________

-Current- Code 6300: Asiatic
cholera is an infection in the small intestine that causes severe diarrhea
and vomiting. The 100% rating for this condition continues for 3 months after
the active infection. If there are symptoms left over after the 3-month period,
then they are rated separately. These symptoms could include papillary
necrosis, which is rated under code 7538.

-Final-Code 6300: Vibriosis (cholera and non-cholera) is an
infection in the small intestine caused by Vibrio
bacteria. It is rated on the General Rating System. Lasting side effects could
include renal failure, skin conditions, and musculoskeletal conditions (like necrotizing fasciitis).

Currently, this code only covers Asiatic
cholera, which is caused by the Vibrio
bacteria. This bacteria, however, can cause many other types of infections as
well. To ensure that those infections are properly recognized and rated, the VA
is changing this code to include all Vibrio
infections. The other change to this code is to eliminate the 100% rating for
the 3 months after the active infection since modern treatments allow full
recovery in a fairly short time period.

__________________________________________________________________

-Current- Code 6301: Visceral
leishmaniasis is a disease of parasites in the
internal organs that can cause symptoms like weight loss, fever, and anemia.
The 100% rating for this condition continues for the first 6 months after
treatment for this disease ends. It is then reevaluated, and any remaining
symptoms or side effects are rated separately. These symptoms could include
liver damage, which is rated under code 7312.

-Final -Code 6301: Visceral
leishmaniasisis a disease of parasites in the internal organs
that can cause symptoms like weight loss, fever, and anemia. It is rated 100%
while it is active. The 100% rating for this condition continues for the first
6 months after the final treatment once the disease is no longer active. It is
then reevaluated, and any remaining side effects are rated separately. These side effects could include liver damage, bone marrow diseases, or leishmaniasis of the skin.

If the infection recurs, it must be officially
confirmed by culture, histopathology, or other lab test.

The only changes to this code are to
include bone marrow diseases and dermal leishmaniasis in the list of potential
residuals and to specify that any recurrence must be properly confirmed by lab
test.

_________________________________________________________________

-Current- Code 6302: Leprosy (or
“Hansen’s Disease”) is a bacterial disease that attacks the skin, nerves,
and airways. It causes severe skin damage and can lead to many other conditions
if left untreated. The 100% rating for this condition continues for the first 6
months after treatment for this disease ends. It is then reevaluated, and
any remaining symptoms or side effects are rated separately. These symptoms
could include skin damage, codes 7800–7805, or
nerve damage. Nerve damage is a bit complicated to rate, and the code depends
on which nerves are damaged. Thorough information on rating nerve damage can be
found on The Central Nervous System page.

-Final-Code 6302: Leprosy (or “Hansen’s Disease”) is a bacterial disease that attacks the
skin, nerves, and airways. It causes severe skin damage and can lead to many
other conditions if left untreated. The 100% rating for this condition
continues for the first 6 months after treatment for this disease ends. It is
then re-evaluated, and any remaining side effects are rated separately.
These side
effects could include skin damage, nerve damage, or amputation.

The VA is adding amputations to the list of
possible residuals since leprosy can lead to auto-amputation.

__________________________________________________________________

-Current- Code 6304: Malaria is a
disease of parasites that infect red blood cells and cause severe fevers and
other symptoms. For malaria to be properly diagnosed, it must be confirmed by
blood smear tests unless it is clear that the veteran was in
an area where contamination could be very likely. The 100% rating for this
condition continues only while the condition is active. Afterwards, any
remaining side effects are rated separately. These symptoms could include liver
damage, which is rated under code 7312.

-Final-Code 6304: Malaria is a disease of parasites that infect red blood cells and cause severe
fevers and other symptoms. It is rated on the General Rating System. For malaria to be properly diagnosed (initially and for any recurrence),
it must be confirmed by blood smear tests or lab tests, like antigen
detection, immunologic tests, and molecular tests. Side effects could include liver damage, spleen damage, renal disease, and central nervous system conditions.

The VA is now requiring proper tests to
diagnose all cases of malaria before they can be rated. They are also adding a
few potential symptoms to the list, though these lists are never exhaustive.

___________________________________________________________________

-Current- Code 6305: Lymphatic filariasis is a
disease of parasites that infect the lymphatic system, including the lymph
nodes. The 100% rating for this condition continues only while the condition is
active. Afterwards, any remaining symptoms or side effects are rated
separately. These symptoms could include epididymitis, which is rated under
code 7525.

-Final-Code 6305: Lymphatic filariasis (“elephantiasis”)is a disease of parasites that infect the
lymphatic system, including the lymph nodes. It is rated on the General Rating System.Side
effects could include epididymitis and various lymphatic conditions.

The only change here is to include the name
“elephantiasis” that is commonly used to refer to this condition and to include
various lymphatic conditions in the list of side effects.

__________________________________________________________________

-Current- Code 6306: Bartonellosis is a
bacterial infection which can cause many other diseases including trench fever,
chronic bacteremia, endocarditis, neurological conditions, Carrion’s
disease, cat-scratch disease, bacillary angiomatosis,
peliosis hepatis, and chronic lymphadenopathy. All of these conditions are
rated under this code. The 100% rating for this condition continues for three
months after the condition is active. Afterwards, any remaining symptoms or
side effects are rated separately. These symptoms could include skin damage,
which is rated under codes 7800–7805.

-Final- Code 6306: Bartonellosis is a bacterial
infection which can cause many other diseases including trench fever, chronic
bacteremia, neurological conditions, Carrion’s disease, cat-scratch
disease, bacillary angiomatosis, peliosis hepatis, and chronic lymphadenopathy.
All of these conditions are rated under this code.

Again, not a huge
change. The VA is removing the three-month rating since this condition is
usually easily treated and is including endocarditis as a potential side
effect.

___________________________________________________________________

-Current- Code 6307: Plague (any
kind) is a bacterial infection that can attack different parts of the body. It
can be treated if caught early. The 100% rating for this condition continues
only while the condition is active. After that, any remaining side effects or
symptoms are rated separately. These symptoms could include gangrene that could
lead to amputation. It would then be rated on the amputation of the particular
body part. See the Amputations page for a complete list of amputation
ratings. In addition to gangrene, this condition could also cause nerve or
brain damage. The code depends on the extent of the nerve or brain damage. All
nerve and brain conditions are discussed on The Central Nervous System page.

-Final- Code 6307: Plague (any kind) is a bacterial infection that can
attack different parts of the body. It is rated on the General Rating System.

Treatments for the plague are advanced to
the point that residuals or side effects are very rare. They can absolutely be
rated if they occur, but the VA feels that they no longer need to be directly
discussed.

___________________________________________________________________

-Current- Code 6308: Relapsing fever is a
bacterial infection that causes fevers, chills, aches, and nausea that can last
between 2 and 9 days. Every couple of weeks, these symptoms return if not
treated with antibiotics. The 100% rating for this condition continues only
while the condition is active. After that, any remaining side
effects or symptoms are rated separately. These symptoms could include liver
damage, code 7312, spleen damage, codes 7706-7707, or nerve damage. The code for nerve damage
depends on which nerve is affected and the severity of the damage. Thorough
information on rating nerve damage can be found on The Central Nervous System page.

-Final- Code 6308: Relapsing fever is a bacterial
infection that causes fevers, chills, aches, and nausea that can last between 2
and 9 days. Every couple of weeks, these symptoms return if not treated with
antibiotics. It is rated on the General Rating System. Side effects could
include liver damage, spleen damage, choroidopathy, or central nerve damage.

The VA is adding choroidopathy (like
iritis, uveitis, etc.) as a potential side effect.

___________________________________________________________________

-Current- Code 6309: Rheumatic fever is a
disease that affects the tissues of the body, causing them to swell. It can
damage the valves of the heart, which can cause congestive heart failure.
Symptoms also include rashes, twitching in the face and
arms, and fevers. The 100% rating for this condition continues only while the
condition is active. After that, any remaining side effects or symptoms are
rated separately. These symptoms could include heart damage, code 7020.

-Final- Code 6309: Rheumatic fever is a disease that
affects the tissues of the body, causing them to swell. It can damage the
valves of the heart, which can cause congestive heart failure.
Symptoms also include rashes, twitching in the face and arms, and fevers. It
is rated on the General Rating System. Side effects could include heart damage,
code 7020.

The only change to this code is for it to
be rated on the General Rating System.

-Current- Code 6311: Miliary
tuberculosis is tuberculosis that began in the lungs
but then traveled to other parts of the body. This condition would be rated for
both pulmonary and nonpulmonary tuberculosis. (Their 100% ratings,
however, cannot be combined during the 1-year period after inactivity. Their
symptoms or complications, however, can be rated during that period instead of
waiting for reevaluation at the 1-year mark).

-Final- Code 6311: Miliary tuberculosis is tuberculosis that
began in the lungs but then traveled to other parts of the body. This
condition would be rated for both pulmonary

and nonpulmonary
tuberculosis if both are still present. (Their 100% ratings, however, cannot be
combined during the 1-year period after inactivity. Their symptoms or
complications, however, can be rated during that period instead of waiting for
reevaluation at the 1-year mark).

If the infection recurs, it must be officially
confirmed by culture, histopathology, or other lab test.

The VA effectually only added a note to
require the proper testing to confirm any recurrence.

___________________________________________________________________

- NEW CODE- Code 6312: Non-tuberculosis
mycobacterial infection (“NTM”)is a lung infection, that
isn’t tuberculosis, which occurs when bacteria is inhaled. This can cover a
wide-range of infections caused by different types of inhaled bacteria. This
condition is rated 100% while active. Once inactive, the condition is
re-evaluated, and any side effects, like skin conditions, respiratory conditions, eye conditions, digestive conditions, etc., can be rated
separately.

If the infection recurs, it must be officially
confirmed by culture, histopathology, or other lab test.

The VA is adding this new code to cover all
inhaled bacterial infections. Currently, tuberculosis is the only code similar
enough to cover these infections, but tuberculosis presents differently and has
more severe long-term implications than many of these other infections. As
such, this code will allow a clearly distinct rating option for these
conditions.

-Current- Code 6316: Brucellosis is a
bacterial infection that causes fevers, headaches, depression, and weakness.
The symptoms can come and go throughout the rest of your life if the disease is not properly treated with antibiotics. The 100% rating for
this condition continues only while the condition is active. After that, any
remaining side effects or symptoms are rated separately. These symptoms could
include liver damage, code 7312, or meningitis, code 8019.

The VA is requiring
the appropriate tests to diagnose the condition in order to ensure both proper
rating and proper treatment, and is expanding the list of potential side
effects.

____________________________________________________________________

-Current- Code 6317: Scrub typhus is
an infection caused by parasites that can be treated with antibiotics, although
many strains are not responsive to treatments. The 100% rating for this
condition continues while the condition is active and for
the first 3 months following. After that, any remaining side effects or
symptoms are rated separately. These symptoms could include skin damage,
codes 7800–7805,
and spleen damage, codes 7706-7707.

The VA is broadening the name of this code to
include all conditions caused by rickettsial infections, not just scrub typhus.
These conditions are already rated analogously under this code, but this change
will make it easier to rate them. They are also removing the 3-month rating
after the active infection since these infections are easily controlled by
modern medicines.

____________________________________________________________________

-Current- Code 6318: Melioidosis is a
bacterial infection that causes pain, coughing, pneumonia
and skin infections. The 100% rating for this condition continues only while
the condition is active. After that, any remaining side effects or symptoms are
rated separately. These symptoms could include arthritis, code 5003, lung tissue damage, code 6825, or meningitis, code 8019.

-Final- Code 6318: Melioidosis is a bacterial
infection that causes pain, coughing, pneumonia, and skin infections. Diagnosis
and any recurrence must be confirmed by culture or appropriate lab testing. It
is rated on the General Rating System. Side effects could include arthritis, meningitis,
and lung lesions.

The VA is requiring the
appropriate tests to diagnose the condition in order to ensure both proper
rating and proper treatment.

____________________________________________________________________

-Current- Code 6319: Lyme disease is a
bacterial disease common in the US and spread by ticks. Symptoms include fever,
skin rash, fatigue, and depression and can affect the joints, heart and nerves if it is not treated properly. The 100% rating for this
condition continues only while the condition is active. After that, any
remaining side effects or symptoms are rated separately. These symptoms could
include arthritis, codes 5002-5003, heart damage, code 7020, chronic fatigue, code 6354, and nerve damage.

-Final- Code 6319: Lyme disease is a bacterial
disease common in the US and spread by ticks. Symptoms include fever, skin
rash, fatigue, and depression and can affect the joints, heart, and
nerves if it is not treated properly. It is rated on the General Rating
System. Side effects could include arthritis, Bell’s palsy, nerve damage, eye conditions, and mental dysfunction.

The only change is to
adjust the side effects list to include the most common side effects for this
condition.

-NEW Code-Code 6325:Hyperinfection
syndrome (“disseminated strongyloidiasis”)is a parasitic disease caused
by roundworms. Symptoms include severe infections, diarrhea, skin rash, and
weight loss. It is rated 100% while active. Once it is inactive, it is
re-evaluated and rated on any remaining side effects.

The VA is adding a new code for hyperinfection syndrome, a condition
that presents unique symptoms and causes an incredibly severe infection with a
high mortality rate and vast, significant side effects.

____________________________________________________________________

-NEW Code-Code 6326:Shistosomiasis
(“Katayama
syndrome”) is an extremely common parasitic disease outside of the US.
Symptoms include skin rash, fever, and headaches. This condition is usually
mild in most people, but some can have negative reactions to the parasite eggs
that can cause long-term side effects. Since the active infection itself is
mild, it is rated 0%. However, in cases that cause side effects, like liver damage, digestive conditions, genitourinary conditions, female reproductive conditions, or central nervous conditions, they can be rated separately.

The VA is adding a new code for shistosomiasis, a unique condition that
is usually mild but can have significant disabling effects in some veterans.
This code will allow those veterans affected to be properly rated.

The VA is adding this new code to avoid having to rate these fevers
analogously.

____________________________________________________________________

-NEW Code-Code 6330:Campylobacter
jejuni is a common type of food poisoning. Symptoms include diarrhea, nausea,
and fever. It is rated on the General Rating System. Side effects could include
uveitis, Guillain-Barre syndrome, and reactive arthritis.

The VA is adding this new code to avoid having to rate it
analogously.

-NEW Code-Code 6333:Salmonella infections (non-typhoid)is a common type of food
poisoning. Symptoms include diarrhea, nausea, and fever. It is rated on the
General Rating System. Side effects could include reactive arthritis and more.

The VA is adding this new code to avoid having to rate it
analogously.

-NEW Code-Code 6334:Shigella
infections (including dysentery)are the most common cause of diarrhea.
It is rated on the General Rating System. Side effects could include hemolytic-uremic syndrome and reactive arthritis.

The VA is adding this new code to avoid having to rate it
analogously.

-NEW Code-Code 6335:West
Nile virus infections are spread by mosquitoes. Symptoms include headache,
vomiting, and fever. It is rated on the General Rating System. Side effects can
include physical, functional, and cognitive conditions.

The VA is adding this new code to avoid having to rate it
analogously.

-Current- Code 6351: HIV (human immunodeficiency
virus) is a virus mostly spread by sexual contact with an
infected person, although it can also be spread from mother to child or by
contact with infected blood. The virus attacks “T4” cells that support the
immune system of the body, thus causing the body to be very vulnerable to
infections, other diseases (“secondary diseases”), and cancers. The HIV virus
can cause the disease AIDS (acquired immunodeficiency syndrome). It takes many
years for an HIV infection to develop into AIDS. The presence of AIDS is
confirmed if the T4 cell count is less than 200.

If a higher rating can be
received by rating a secondary disease or infection than can be received by
rating HIV or AIDS, then it can be rated under that secondary condition. A
rating for both, however, is not allowed—only a rating for HIV or a rating for
ONE of the secondary conditions, whichever can provide the higher rating. If it
is rated on one of the secondary conditions, then the final code will look like
this: 6351-4901. The first four-digit code defines the condition as HIV, and
the second four-digit code tells how the condition is rated.

The ratings:

If there is an active AIDS
disease with either regularly occurring infections/diseases or
infections/diseases in numerous areas of the body, it is rated 100%. A 100%
rating is also given for HIV if there is a secondary disease that is present
the majority of the time and causes continual weight loss.

If there is a secondary
disease, infection, or neoplasm as a result of AIDS, then the minimum rating is
60%. This rating is also given if there are significant symptoms throughout the
body that cannot be controlled, diarrhea, and weight loss.

If the HIV is being treated
by “approved” medication (medications that are prescribed for research by a
qualified medical institution), but there are still regularly occurring
symptoms throughout the body and intermittent diarrhea, then it is rated 30%. This
rating is also the minimum rating given if the T4 cell count is less than 200,
there is hairy cell leukoplakis, or oral candidiasis.

If the HIV is being treated
by “approved” medication, there are at least definite symptoms present, and the
T4 cell count is between 200 and 500, then it is rated 10%. If there are clear
signs of depression or memory loss that interfere with the ability to work, a
rating of 10% may also be given.

If there are no symptoms
that affect the ability of the individual to function, then it is rated 0%,
even if there is a decreased T4 cell count, disease in the lymph nodes, or
diagnosed AIDS.

-Final- Code 6351: HIV (human immunodeficiency virus) is a virus mostly
spread by sexual contact with an infected person, although it can also be
spread from mother to child or by contact with infected blood. The virus
attacks “T4” cells that support the immune system of the body, thus causing the
body to be very vulnerable to infections, other diseases (“secondary
diseases”), and cancers.

The HIV virus can cause the disease AIDS
(acquired immunodeficiency syndrome). It takes many years for an HIV infection
to develop into AIDS. The diagnosis of AIDS is confirmed if the T4 cell count
is less than 200 or if there is the presence of one of the following opportunistic
infections in addition to HIV.

Opportunistic Infections

- Candidiasis of the bronchi, trachea,
esophagus, or lungs

- Invasive cervical cancer

- Coccidioidomycosis

- Cryptococcosis

- Cryptosporidiosis

- Cytomegalovirus (including CMV retinitis)

- Encephalopathy

- Herpes simplex-chronic ulcers (must be
present more than 1 month)

- Bronchitis

- Pneumonia

- Esophagitis

- Histoplasmosis

- Chronic intestinal isosporiasis

- Kaposi’s sarcoma

- Lymphoma

- Mycobacterium avium complex

- Tuberculosis

- Pneumocystis jirovecii pneumonia

- Recurrent pneumonia

- Progressive multifocal leukoencephalopathy

- Recurrent Salmonella septicemia

- Toxoplasmosis of the brain

- Wasting syndrome

Secondary diseases or infections, like
diagnosed mental disorders, opportunistic infections, neoplasms, and central nervous system conditions, may be rated separately in addition to a
rating under this code as long as symptoms do not overlap (Pyramiding Principle).
For example, chronic bronchitis can be rated in addition to a rating under this
code as the ratings cover different symptoms. However, a rating for Major
Depressive Disorder cannot be given in addition for a 10% rating based on
depression under this code as they both are rating the symptom of depression.
In these cases, only one rating can be given.

The ratings:

If there is AIDS and an opportunistic
infection or a disease that affects numerous areas of the body, it is
rated 100%. A 100% rating is also given for HIV if there is a secondary disease
that is present the majority of the time and causes continual weight loss.

If there is an opportunistic infection or
neoplasm, then the minimum rating is 60%. This rating is also given if there
are diarrhea, weight loss, and other significant symptoms throughout the body
that cannot be controlled.

If the HIV is being treated by “approved”
medication (medications and treatment regimens that are prescribed for research
by a qualified medical institution), but there are still regularly occurring
symptoms throughout the body and intermittent diarrhea, then it is rated 30%.
This rating is also the minimum rating given if the T4 cell count is less than
200.

If the HIV is being treated by “approved”
medication, there are definite symptoms present, the T4 cell count is between
200 and 500, or there are clear signs of depression or memory loss that
interfere with the ability to work, a rating of 10% is given.

If there are no symptoms that affect the
ability of the individual to function, then it is rated 0%, even if there is a
decreased T4 cell count and lymph node disease.

The VA is making a
number of changes to this code to better rate HIV based on current medical
understandings and treatments. The VA is adding a list of opportunistic
infections to help diagnose the presence of AIDS and allow for more clarity
when rating secondary conditions. They are further clarifying that secondary
conditions can be rated in addition to a rating under this code as long as
there is no pyramiding.

Code 6354 for chronic fatigue syndrome will remain the same. The VA originally proposed making significant
changes to this code and the diagnosis criteria for CFS back in February.
However, they received enough comments refuting the lack of evidence supporting
the proposed changes that the VA decided to not making any adjustments to this
code until additional research can be performed to best know how to update
these ratings.

Still's Disease will continue to be rated analogously on it's symptoms, however, since you also have CFS, it is highly likely that the VA will give only a single rating for both conditions combined under the CFS code since they share similar symptoms. CFS, however, does not cover skin symptoms, so that would probably still be rated separately.

Rheumatoid arthritis also presents a tricky rating situation since CFS and Still's also cause joint pain. A single symptom (joint pain) can only be rated once, so the VA would look at your overall picture and choose that code that best covers your symptoms.

That was alway the intent of this code, so it isn't actually a change. The VA adjusted the language slightly to make it more clear, but the practice of requiring a bed rest prescription to count as an incapacitating episode has always been the rating standard of this code.